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Hippocampal Resection (hippocampal + resection)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Epilepsy with dual pathology: Surgical treatment of cortical dysplasia accompanied by hippocampal sclerosis

EPILEPSIA, Issue 8 2010
Dong W. Kim
Summary Purpose:, The presence of two or more epileptogenic pathologies in patients with epilepsy is often observed, and the coexistence of focal cortical dysplasia (FCD) with hippocampal sclerosis (HS) is one of the most frequent clinical presentations. Although surgical resection has been an important treatment for patients with refractory epilepsy associated with FCD, there are few studies on the surgical treatment of FCD accompanied by HS, and treatment by resection of both neocortical dysplastic tissue and hippocampus is still controversial. Methods:, We retrospectively recruited epilepsy patients who had undergone surgical treatment for refractory epilepsy with the pathologic diagnosis of FCD and the radiologic evidence of HS. We evaluated the prognostic roles of clinical factors, various diagnostic modalities, surgical procedures, and the severity of pathology. Results:, A total of 40 patients were included, and only 35.0% of patients became seizure free. Complete resection of the epileptogenic area (p = 0.02), and the presence of dysmorphic neurons or balloon cells on histopathology (p = 0.01) were associated with favorable surgical outcomes. Patients who underwent hippocampal resection were more likely to have a favorable surgical outcome (p = 0.02). Conclusions:, We show that patients with complete resection of epileptogenic area, the presence of dysmorphic neurons or balloon cells on histopathology, or resection of hippocampus have a higher chance of a favorable surgical outcome. We believe that this observation is useful in planning of surgical procedures and predicting the prognoses of individual patients with FCD patients accompanied by HS. [source]

Does cortical mapping protect naming if surgery includes hippocampal resection?

ANNALS OF NEUROLOGY, Issue 3 2010
Marla J. Hamberger PhD
Objective Preresection electrical stimulation mapping is frequently used to identify cortical sites critical for visual object naming. These sites are typically spared from surgical resection with the goal of preserving postoperative language. Recent studies, however, suggest a potential role of the hippocampus in naming, although this is inconsistent with neurocognitive models of language and memory. We sought to determine whether preservation of visual naming sites identified via cortical stimulation mapping protects against naming decline when resection includes the hippocampal region. Methods We assessed postoperative changes in visual naming in 33 patients, 14 who underwent left temporal resection including hippocampal removal and 19 who had left temporal resection without hippocampal removal. All patients had preresection cortical language mapping. Visual object naming sites identified via electrical stimulation were always preserved. Results Patients without hippocampal resection showed no significant naming decline, suggesting a clinical benefit from cortical mapping. In contrast, patients who had hippocampal resection exhibited significant postoperative naming decline, despite preresection mapping and preservation of all visual naming sites (p , 0.02). These group effects were also evident in individual patients (p = 0.02). More detailed, post hoc examination of patients who had hippocampal resection revealed that overall, patients who declined were those with a preoperative, structurally intact hippocampus, whereas patients with preoperative hippocampal sclerosis did not exhibit significant decline. Interpretation Despite cortical language mapping with preservation of visual naming sites from resection, removal of an intact dominant hippocampus will likely result in visual naming decline postoperatively. ANN NEUROL 2010;67:345,352 [source]

Regional energetic dysfunction in hippocampal epilepsy

ACTA NEUROLOGICA SCANDINAVICA, Issue 4 2005
J. W. Pan
Objectives , There is increasing evidence for a dysfunctional metabolic network in human mesial temporal lobe epilepsy (MTLE). To further describe this, we evaluated the bioenergetic status in unilateral MTLE inter-regionally and in relation to neuropathology. Materials and methods , We used whole brain high field (4 T) 31P MR spectroscopic imaging to determine in vivo PCr and ATP, studying n = 22 patients (all candidates for hippocampal resection) and n = 14 control volunteers. The degree of bioenergetic impairment was assessed by calculating the ratio of PCr to ATP. Results, Compared to controls, patients demonstrated significant decreases in PCr/ATP from the ipsilateral amygdala and pes (0.84 ± 0.14, 0.87 ± 0.10, respectively, patients vs 0.97 ± 0.15, 0.98 ± 0.16, controls). In patients, the ipsilateral thalamic energetics positively correlated with contralateral hippocampal energetics. In addition, the ipsilateral thalamic and striatal energetics negatively correlated with hippocampal total glial counts. Conclusions, These data are consistent with a view that in MTLE, the bilateral hippocampi, ipsilateral thalamus and striatum are linked in their energetic depression, possibly reflecting the propagation of seizures throughout the brain. [source]

Predictors of seizure outcome after temporal lobectomy for intractable epilepsy

ACTA NEUROLOGICA SCANDINAVICA, Issue 4 2004
K. Stavem
Objectives , To assess predictors of outcome of temporal lobectomy for intractable epilepsy. Material and methods , In 63 adult patients operated with anterior temporal lobectomy during 1988,92, we used logistic regression analysis to assess predictors of being seizure-free (Engel's class I) 2 years after surgery. As potential predictors, we included the following variables: gender, age at operation, age at onset of seizures, epilepsy duration, etiology, generalized vs not generalized seizures, seizure frequency, intelligence quotient, ictal electroencephalography, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), side of resection, and extent of the resection. Results , About 44% of the surgery patients were seizure-free (Engel's class I) 2 years after surgery. In multivariate analysis (n = 55), MRI pathology defined as atrophy in the temporal lobe, angioma, tumor or mesial temporal sclerosis (odds ratio, OR 7.4, 95%CI: 1.7,32.9) and extent of the hippocampal resection (increase of 1 cm) (OR 2.2, 95%CI: 1.1,4.6) predicted being seizure-free. Conclusion , Focal pathology in preoperative MRI and the extent of the hippocampal resection were the only significant predictors of being seizure-free after 2 years. [source]